This week, we are diving deeper into dementia.
While many people recognize the name, few understand the mechanics behind it:
Why does it happen, and how does it progress?
What is Dementia?
Dementia is a progressive brain condition that
often begins subtly. Usually, the first noticeable sign is a struggle with
short-term memory. As the condition advances, it affects different regions of
the brain, leading to changes in mood, behavior, sleep patterns, and even
hallucinations. Eventually, these limitations impact daily activity until the
individual requires full-time care.
Not All Dementia is the Same
While the description above fits Alzheimer’s
Disease (the most common type), different forms follow different paths:
• Alzheimer’s Disease: Characterized
by a slow, steady decline in memory and cognitive function.
• Vascular Dementia: The second
most common type. It often starts abruptly (usually after a stroke) and
progresses in a "step-ladder" pattern—staying stable for a while,
then declining suddenly.
• Frontotemporal Dementia: Typically
begins with noticeable changes in personality and social behavior rather than
memory loss.
• Lewy Body Dementia: Often associated with vivid visual hallucinations and motor (movement) issues.
Who is at Risk? (The "Why")
The Lancet Commission has categorized dementia
risk factors across the lifespan. Understanding these is the first step toward
prevention:
• Early Life: Lower
educational attainment (the most powerful modifiable factor).
• Midlife: Hearing loss,
high LDL cholesterol, depression, traumatic brain injury, physical inactivity,
diabetes, smoking, hypertension, obesity, and excessive alcohol consumption.
• Late Life: Social
isolation, air pollution, and vision loss.
The Sub-Saharan African Context
In Sub-Saharan Africa, factors such as untreated
hypertension, diabetes, and infectious diseases—including HIV and cerebral
malaria—play a more prominent role. Genetic predispositions exist, but
environmental "triggers" like air pollution and shared dietary habits
often activate these risks.
The Power of Cognitive Reserve: Think of
"Cognitive Reserve" as your brain’s ability to improvise. While
dementia is often viewed as "accelerated aging," how rapidly it sets
in depends on this reserve. Building it starts with quality education in
childhood and continues through lifelong learning and mental stimulation.
A Closer Look: Vascular Dementia
Vascular dementia occurs when the integrity of
the blood vessels is disrupted, damaging the brain. This can happen in a few
ways:
1. Post-Stroke:
Occurring within six months of a major stroke.
2. Multi-Infarct:
Following a large number of "silent" strokes (small areas of dead
tissue called infarcts) that are only visible on brain imaging.
3. Mixed
Dementia: Occurring alongside Alzheimer’s disease.
Why this matters for Nigeria and Africa: While
Alzheimer’s is the most common type globally, Vascular Dementia may be a
significantly larger problem in Nigeria and across Africa.
Data shows that the African populations have a
higher prevalence of hypertension and diabetes compared to other races. It is
estimated that around 50-60% of the adult population in Africa has high blood
pressure. If these diseases are more common in our population, the impact of
vascular dementia is likely to be much greater for us. Vascular dementia is
strongly linked to habits and conditions that disrupt blood vessels: heart and
renal disease, obesity, sedentary behavior, and obstructive sleep apnea.
Dementia is complex, but it is not always
inevitable. By managing blood pressure, treating sensory loss, and staying
mentally active, we can build a resilient brain. Protecting your brain is
protecting who you are.
Reference
Dementia prevention, intervention, and care:
2024 report of the Lancet standing Commission.
Dementia in sub-Saharan Africa: Challenges and
opportunities.
CONTINUUM (MINNEAP MINN) 2024;30(6,
DEMENTIA):1699–172.
Disclaimer: This content is for informational purposes only and is not a substitute for professional medical advice.
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